Individual
MRS. TRACY GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.I.
Contact information
Practice address
3345 TORI TRAIL LN, WEST PADUCAH, KY 42086-9859
(270) 562-2065
(270) 534-5036
Mailing address
3345 TORI TRAIL LN, WEST PADUCAH, KY 42086-9859
(270) 562-2065
(270) 534-5036
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
05/14/2007
Last updated
06/20/2016
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